title: Complications after body contouring surgery in post-bariatric patients: the importance of a stable weight close to normal.
abstract: OBJECTIVE
  Body contouring surgery is in high demand following the increase in bariatric surgery. Massive weight loss leads to an excess of lax, overstretched skin causing physical and psychosocial discomfort. Plastic surgical procedures can give rise to an improvement in quality of life, but the relative high complication rate could negatively affect these potential gains. The purpose of this study is to identify predictors of complications in order to optimize outcomes in this patient population.
  
  
  METHODS
  Out of a group of 465 post-bariatric patients, 61 patients underwent body contouring surgery following massive weight loss. A total of 43 respondents were reviewed retrospectively for demographic data, pre- and post-operative weight status and co-morbidities. Medical complications were categorized according to the modified Clavien classification. All cases were analyzed for risk factors.
  
  
  RESULTS
  A stable weight over a period of at least 3 months prior to body contouring surgery is associated with a significant lower complication rate (odds ratio 0.24; CI 0.07-0.79) and the percentage excess weight loss (odds ratio 0.96; 95% CI 0.92-1.00) was an independent predictor for the occurrence of complications. The overall complication rate was 27.9% with a major complication rate of 8.8%. Most frequent procedures were abdominoplasty (61%) and breast reduction/ mammapexy (25%).
  
  
  CONCLUSIONS
  This study emphasizes the importance to strive for a stable weight close to normal before surgery to minimize the risk of complications. The positive effects of the long-term results of bariatric surgery tolerate the relative high complications rate. Careful pre-operative planning and patient selection are essential to optimize the results of body contouring surgery of post-bariatric patients.
authors.affiliation: Department of Plastic and Reconstructive Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Eva S J
authors.initials: ES
authors.lastname: van der Beek
authors.forename: Aebele Mink
authors.initials: AM
authors.lastname: van der Molen
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
mesh_terms: D000328:Adult; D050110:Bariatric Surgery; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000523:psychology* / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology*; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D015431:Weight Loss / Q000502:physiology*; D055815:Young Adult